Assessment of preoperative frailty and identification of patients at risk for postoperative delirium in cardiac intensive care units: a prospective observational study

Abstract

Background Postoperative delirium (POD) is a common complication that may occur from 24 to 72 h after cardiac surgery. Frailty is a chronic syndrome that leads to a decline in physiological reserve and to disability. The associations between frailty and POD are unclear. Aims To investigate associations between POD and frailty in patients undergoing cardiac surgery and to analyse predictors of POD. Methods and results Convenience sampling was used to recruit 152 patients who underwent cardiac surgery in two medical centres in northern Taiwan. Preoperative frailty in these patients was evaluated using Fried’s frailty phenotype. Delirium in patients was assessed from postoperative day 1 to day 5 using the confusion assessment method for intensive care units. A total of 152 patients who underwent cardiac surgery included 68 (44.74%) prefrail patients and 21 (13.81%) patients with frailty after the surgery. Ten patients (6.58%) developed delirium after cardiac surgery. The occurrence of delirium peaked at postoperative day 2, and the average duration of delirium was 3 days. A case–control comparison revealed a significant correlation between preoperative frailty and POD. Significant predictors of POD in patients undergoing cardiac surgery included the European System for Cardiac Operative Risk Evaluation II, preoperative arrhythmia, and preoperative anxiety and depression. Conclusion Preoperative frailty was correlated with POD. Preoperative arrhythmia, anxiety, and depression are predictors of POD. Nurses should perform preoperative assessments of surgical risk and physiological and psychological conditions of patients undergoing cardiac surgery and monitor the occurrence of POD.

Melatonin and Its Analogs for Prevention of Post-cardiac Surgery Delirium: A Systematic Review and Meta-Analysis

“…A recent study indicated that most cases of delirium occur between days 1 and 3 after cardiac surgery ( 61 ); which may explain the lack of a significant difference observed in the long-term group. The mean duration of POD was 3 days after cardiac surgery ( 62 ). Therefore, it may be appropriate to administer melatonin preoperatively and continue its administration until postoperative day 6.…”

Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis

“…These 11 studies enrolled in total 1691 participants with a mean age between 63.1-82.3 years undergoing cardiac surgery (n = 6) [12,13,37,38,40,41], hip fracture surgery (n = 2) [29,32], orthopedic surgery (n = 1) [11], tumor resection surgery (n = 1) [10], and prolapse surgery (n = 1) [39]. Nine prospective cohort studies [10-12, 29, 37-41] and two secondary data analyses of prospective studies [13,32] were conducted in Belgium (n = 3) [12,13,32], the Netherlands (n = 2) [29,37], China (n = 2) [11,38], Japan (n = 2) [10,41], United States of America (n = 1) [39], and Sweden (n = 1) [40]. More details can be found in Table 1.…”

“…Four studies [11,29,37,40] were rated as "unclear" in question 3 (Q3) of JBI checklist and Q7 for failing to report whether preoperative anxiety and POD were measured by trained raters. Besides, Five studies [10,[38][39][40][41] were "unclear" whether patients with pre-operative delirium were excluded (Q6). In terms of follow-up, Bakker 2012 [37] and Segernäs 2022 [40] didn't report if there were participants lost during follow-up, and Slor 2013 [29] didn't explicitly state how long the in-hospital period was (Q9 and Q10).…”

“…In terms of follow-up, Bakker 2012 [37] and Segernäs 2022 [40] didn't report if there were participants lost during follow-up, and Slor 2013 [29] didn't explicitly state how long the in-hospital period was (Q9 and Q10). Regarding the questions rated as "not applicable", no patients were lost to follow-up in Cheng 2021 [38] (Q 10), and the primary objective of Slor 2013 [29] was not focused on the relationship between preoperative risk factors and POD (Q5 and Q11). In the study of Fukunaga 2022 [41] POD was evaluated within two / three days after surgery which was rather short considering POD may occur up to one week postoperatively (Q8).…”

“…The details of preoperative anxiety and POD assessment are presented in Table 1 [39]. For the studies that reported the proportions of anxious patients, preoperative anxiety was defined as a HADS-A score of eight and greater on a maximum total score of 21 [10,11,38], STAI-S score of seven and greater on a maximum total score of 10 [12], and APAIS-A score of 11 and greater on a maximum total score of 20 [13]. Nine studies also reported the mean anxiety scores [10,12,13,29,32,37,[39][40][41].…”